About two hundred people marched through the streets of Rockhampton in support of Aboriginal people in support of West Australian indigenous people after the government has threatened to withdraw funding from remote communities. Photo: Chris Ison / The Morning BulletinChris Ison

Medical student reacts to closures of remote communities

Plans to shut down remote Aboriginal communities have sparked national outrage among indigenous people.

Former Morning Bulletin journalist Amy Marshall is studying medicine in Western Australia and she has visited remote Aboriginal communities in the Northern Territory.

This is her opinion on the issue:

"HUMBLE thyself before you enter."

The scrawled words on the door of the old man's house danced like a tarantella in my head.

They stayed with me with every step I took through the West Arnhem community of Gunbalanya. They whispered with the gush of grasshoppers and oversized butterflies that sprayed out of the impossibly green grass of the wet season.

They stirred in my chest every time a patient shared something private with me, or took the time to teach me some words or tell me a story about where they were from.

They tumbled down my face in tears when I heard the Sorry Business wailing from the women after the old man passed.

Each time I entered a home, started my day at the clinic, ran out the road past the water buffalo and into the shadows of the Dreamtime stories of the rocks, stood under the gushing water from the waterfalls.

Photos

As I read about our Prime Minister supporting a Western Australian Government decision to cut services to and thereby effectively close about half of the state's 274 remote communities, I heard those words again.

They were words Tony Abbott should have listened to before he visited the communities of Cape York.

And again before he left. If he did, there was no way he could walk away from a remote community and claim Aboriginal people's "lifestyle choice" to live on homelands did not deserve our nation's full support.

"What we can't do is endlessly subsidise lifestyle choices if those lifestyle choices are not conducive to full participation in Australian society that everyone should have." - Tony Abbott, March 2015.

Before even touching on notions of what it means to be a "fully participating Australian", what it means to make a contribution to your community and to your country, and the success of homelands communities in improving the health of Aboriginal people, this view shows a deep lack of understanding about connection to country.

Yet again, it completely ignores more than 40,000 of connection to land and history. It completely ignores the value of acknowledging and protecting the oldest living culture in the world.

The old man shared chocolate cake with family, as dogs fossicked in rubbish on the floor, his thin yellowed mattress right there.

The yawk yawk reached his house in the deluge that night.

In the morning, he was gone.

As a journalist, I am quite easily caught up in word play, rhetoric, sarcastic politics and politics of sarcasm. And I have been a culprit of this in recent weeks, jumping on the light rail carriage of people using the Prime Minister's comments to expose his publicity stunts about prioritising the wellbeing of Aboriginal people for the fraud they are.

But what mustn't be forgotten is what this actually means for people living in remote communities.

The government actually announced these funding cuts in September 2014, and the WA Government announced it was closing at least 100 communities in November.

At the time, it was a hardly a flurry of Twitter feathers. In fact, when I shared the story about this on social media in November, it hardly stirred an instant coffee into something drinkable.

In fact, when I posted it on the Facebook page of one particular medical cohort it didn't receive a single like, share or comment.

But now Tony Abbott has made an awkward, racist and unapologetic tumble into the debate, with words his opponents can use as grenades against him, it has suddenly caused a rocking washing machine of turbulence.

Mr Abbott's words don't practically change much for what was already decided and already in motion.

So what happens when feeding frenzy is over, when the homelands hash-tags and Facebook shares are replaced with another Abbott gaffe?

It was the wet season…

I was a first-year medical student on my first John Flynn Program placement in the remote West Arnhem Land community of Gunbalanya, or Oenpelli. And I had just had my first "medical" experience of death. Sure I had lost loved ones before. I had even been to funerals of Aboriginal people in remote communities before. I'd been telling stories about Aboriginal people and communities for a decade. I understood all of this, didn't I?

His body was riddled with cancer. The Aboriginal Health worker and I went to visit him several times to put a fresh dressing on a lump on his back. Someone apologised for all the rubbish and hurriedly tried to push it into one area. There was no fridge at the house so he kept his medication in a small foam esky. His nephew was helping to take care of him, pushing him around, showering him.

This meant he didn't have to be flown to Darwin and could be taken care of in his own community, on his own country. There was no door on the shower - just a recess in the wall.

There seemed to be many people living in the house, a few dogs as well. It was summer in one of the most northern parts of Australia and there was no air-conditioning, so the smells lingered thick in the steamy, wet season air.

On the third visit, someone had picked up some meals for the family and he was smiling at the chocolate cake and fruit they shared. As I left, I noticed the words on the door.

"Humble thyself before you enter."

In the morning when I went to the clinic I told the doctor the old man had asked for a different wheelchair, that he had some significant ankle swelling and the infection on his back seemed to be getting worse. I was looking forward to seeing him again, to taking him a better wheelchair.

But something in the clinic wasn't right that morning. One of the nurses was crying. I felt silly. I barely knew him. But I couldn't hold back my tears from her shoulder when she saw the reaction on my face and hugged me. Later, I heard the unmistakable wailing.

I was so happy he had been surrounded by his family and feasting on cake the night before. I was overwhelmed with emotion I could not identify at having been in his home for his last meal, his last moments with family, just before he lay down to sleep.

Like so many palliative care patients on community, this man was offered flights to Darwin and top quality care in a first-world hospital. But like so many people on community, he refused.

The local health clinic went above and beyond to care for these people as best they could, and the need to care for elders seemed to bring families together.

But what cannot be ignored, is that at the most vulnerable time of their lives, these people choose third-world living conditions, physical discomfort and sporadic care from people who could only do their best with the limited resources they had.

This is not a lifestyle choice. This is home, a history of tens of thousands of years, knowledge from the world's oldest ecologists, it is law, it is family, it is ancestors, it is life force, it is duty, it is peace.

This is a powerful connection to country we can only begin to grasp tiny seeds of if we actively open our minds and hearts to it.

As it is, humans struggle to perceive the temporal scale at which geology, ecology and evolution, occur. It's like an insect whose whole life cycle occurs in 24 hours trying to understand a 90-year human life.

Like climate change and butterfly life cycles, the concept of Dreamtime is difficult for most to grasp. The idea that everything is connected, that every minutia of country holds ancestors, families, stories, history is best materialised in children's films like Avatar.

But if we are ever to close the gap on Aboriginal health inequalities, we must use our imagination to construct this magic space and time, because nurturing this world view has to be central to the way forward.

This is where the true gap is - a big gaping hole in our understanding and our ability to perceive a world that is not right in front of our nose. A giant black tunnel of vision in thinking our understanding of and interactions with our world are the right, rational and most effective ones.

And as long as we miss this, our own health suffers too. For in this Dreamtime there is a concept of wellbeing that we are losing - a connection to each other, to our natural environment and to ourselves.

We miss out on 40,000 years of history and the wisdom of a society that has progressed well beyond our own in its ability to conceptualise our concerns transgenerationally.

"Tree might be sick, you feel it. You might feel it for two or three years. You get weak, little bit, little bit. Because tree going bit by bit. Dying.

Tree not die when you cut it. He not die tomorrow, he still green. Might be five or six weeks, might be two months. You feel it then.

Your body. You feel it."

- Bill Neidjie, Gagudju Man.

So we have to move beyond the rhetoric to more difficult questions about what constitutes full participation in Australian society, what we mean by "contribution", the ethics of distribution, our commitment to the self-determination and freedom of choice for Aboriginal people, and if we can wrap our heads around the different concepts of health and what factors contribute to health outcomes for Aboriginal people.

But this requires more effort than a Facebook post. The ethics of health care and determination of need are complex.

Needs are inherent, subjective and socially induced. What is "necessary" in one society is not necessary in another and so there cannot be a simple egalitarian solution to the problem of need.

Defining contribution requires moving away from more easily quantifiable measurements of economic contribution in terms of labour force. Economic contribution is not the only form of contribution and payment is not the only form of reward.

Education and public health measures save statistical lives, and the value of elders on homelands as teachers, mentors, cultural educators and parent figures is immeasurable.